In vivo Dentin Microhardness beneath a Calcium-Phosphate Cement

A minimally invasive caries-removal technique preserves potentially repairable, caries-affected dentin. Mineral-releasing cements may promote remineralization of soft residual dentin. This study evaluated the in vivo remineralization capacity of resin-based calcium-phosphate cement (Ca-PO(4)) used for indirect pulp-capping. Permanent carious and sound teeth indicated for extraction were excavated and restored either with or without the Ca-PO(4) base (control), followed by adhesive restoration. Study teeth were extracted after 3 months, followed by sectioning and in vitro microhardness analysis of the cavity floor to 115-mu m depth. Caries-affected dentin that received acid conditioning prior to Ca-PO(4) basing showed significantly increased Knoop hardness near the cavity floor. The non-etched group presented results similar to those of the non-treated group. Acid etching prior to cement application increased microhardness of residual dentin near the interface after 3 months in situ.

In vivo Dentin Remineralization by Calcium-Phosphate Cement

Minimally invasive caries-removal procedures remove only caries-infected dentin and preserve caries-affected dentin that becomes remineralized. Dental cements containing calcium phosphate promote remineralization. This study evaluated the in vivo remineralization capacity of resin-based calcium-phosphate cement (Ca-P) used for indirect pulp-capping. Carious and sound teeth indicated for extraction were randomly restored with the Ca-P base or without base (control), followed by adhesive restoration. Study teeth were extracted after three months, followed by elemental analysis of the cavity floor. Mineral content of affected or sound dentin at the cavity floor was quantified by electron probe micro-analysis to 100-mu m depth. After three months, caries-affected dentin underneath the Ca-P base showed significantly increased calcium and phosphorus content to a depth of 30 mu m. Mineral content of treated caries-affected dentin was in the range of healthy dentin, revealing the capacity of Ca-P base to promote remineralization of caries-affected dentin.

Análise da dentina de dentes decíduos submetidos ao capeamento pulpar indireto

O objetivo do estudo foi avaliar as características da dentina cariada remanescente de molares decíduos quanto à coloração, consistência e microdureza, após um período médio de 3 anos e 8 meses da realização do capeamento pulpar indireto. O estudo clínico constou de 27 dentes que apresentavam lesões cariosas ativas com expressão radiográfica em metade interna de dentina. Aleatoriamente, foi realizado o capeamento pulpar indireto e utilizado como material capeador o hidróxido de cálcio (HC) e o cimento de ionômero de vidro resinoso modificado (CIVRM). As crianças foram acompanhadas através de exames clínicos e radiográficos, e ao longo de um período médio de 3 anos e 8 meses, observou-se um índice de sucesso de 89% para o grupo do HC e de 93% para o CIVRM, não havendo diferença estatisticamente significante entre os dois grupos (p=0,62). Os dentes considerados como sucesso no estudo clínico foram agrupados em um único grupo (grupo teste), que constou de 13 dentes que sofreram esfoliação natural ou exodontia por motivos ortodônticos. Além disso, foram selecionados 15 molares decíduos hígidos (grupo controle positivo) e 15, portadores de lesões cariosas ativas em metade interna de dentina (grupo controle negativo). As amostras do grupo teste tiveram suas respectivas restaurações removidas, a profundidade medida e a dentina remanescente avaliada por um operador calibrado, seguindo critérios descritivos, quanto à consistência e a coloração. Nos dentes do grupo controle positivo, foram realizados preparos cavitários oclusais em até 4 mm de profundidade, enquanto que, no grupo controle negativo, o mesmo operador do estudo clínico realizou a remoção parcial de tecido cariado in vitro. A partir daí, todos os dentes foram preparados para análise de microdureza, que foi realizada por um examinador calibrado, que empregou o princípio de cegamento. Na análise da consistência, todos os dentes do grupo teste (n=13) apresentaram-se endurecidos, enquanto que 9, apresentaram coloração amarela-clara (8 do CIVRM e 1 do HC) e 4, castanho-escura (1 do CIVRM e 3 do HC). Para o teste de microdureza no grupo teste, obteve-se uma média KHN de 40,81 (±16,28) MPa, enquanto que nos grupos controles positivo e negativo, foram alcançados valores médios de 62,73 (±11,24) MPa e 19,15 (±6,99) MPa, respectivamente. A análise estatística mediante o teste ANOVA indicou que houve diferença significativa entre os 3 grupos. Foi constatada a remineralização da dentina de dentes decíduos em que foi realizada a técnica do capeamento pulpar indireto após um período médio de 3 anos e 8 meses, através de critérios clínico (consistência) e laboratorial (análise da microdureza).

Response of the pulp of dogs to capping with mineral trioxide aggregate or a calcium hydroxide cement

This study was conducted to observe the response of dogs' dental pulp to mineral trioxide aggregate (MTA) and a calcium hydroxide cement when used as pulp capping materials. After the pulps of 30 teeth were exposed, they were capped with either MTA or a calcium hydroxide cement. Histological analysis was performed 2 months after treatment. Results showed a healing process with complete tubular dentin bridge formation and no inflammation in any of the pulps capped with MTA. on the other hand, only five specimens from the calcium hydroxide cement group formed a complete dentin bridge. In this experimental group, pulp inflammation was observed in all but three cases. In conclusion, MTA exhibited better results than the calcium hydroxide cement for the capping of the pulp in dogs.

Influence of age on the behavior of dental pulp of dog teeth after capping with an adhesive system or calcium hydroxide

This study evaluated histomorphologically the influence of chronological age of the dog on the dental pulp-healing process after capping with the All Bond 2 system or with calcium hydroxide paste. The animals were divided according to age into young and adult groups. Class 5-type cavities were prepared, and the pulp was submitted to an exposure of a diameter of 0.5 mm. The pulp of the teeth was then protected with the adhesive system or with a calcium hydroxide paste. Sixty days after treatment, the results obtained with the adhesive system in the young group were significantly better than those in the adult group. With calcium hydroxide, the results were similar for both groups. The pulp treated with calcium hydroxide exhibited a complete hard tissue bridge and a pulp without inflammatory reaction, a fact not observed when the adhesive system was used. In conclusion, the chronological age of the pulp influenced the comparative results only for the adhesive system (P = 0.1), and the total results were better with calcium hydroxide than with the All Bond 2 system (P = 0.01).

Evaluation of dental pulp repair using low level laser therapy (688 nm and 785 nm) morphologic study in capuchin monkeys

The aim of this study was to evaluate the hypothesis that low-level laser therapy (LLLT) 688 nm and 785 nm accelerate dentin barrier formation and repair process after traumatic pulp exposure. The sample consisted of 45 premolars of capuchin monkeys (Cebus apella) with pulp exposure Class V cavities. All premolars were treated with calcium hydroxide (Ca(OH)(2)), divided in groups of 15 teeth each, and analyzed on 7(th), 25(th), and 60(th) day. Group GI - only Ca(OH)(2), GIF- laser 688 nm, and GIII - laser 785 nm. Laser beam was used in single and punctual dose with the parameters: continuous, 688 nm and 785 nm wavelength, tip`s area of 0.00785 cm(2), power 50 mW, application time 20 s, dose 255 J/cm(2), energy 2 J. Teeth were capped with Ca(OH)(2), Ca(OH)(2) cement and restored with amalgam. All groups presented pulp repair. On 25(th) day the thickness of the formed dentin barrier was different between the groups GI and GII (p < 0.05) and between groups GI and GIII (p < 0.01). On 60(th) day there was difference between GI and GIII (p < 0.01). It may be concluded that, LLLT 688 nm and 785 nm accelerated dentin barrier formation and consequently pulp repair process, with best results using infrared laser 785 nm. (c) 2009 by Astro Ltd. Published exclusively by WLLEY-VCH Verlag GmbH & Co. KGaA

Histomorphological response of dogs' dental pulp capped with white mineral trioxide aggregate

Foi objetivo deste trabalho estudar a reação do tecido pulpar ao capeamento com agregado de trióxido mineral (MTA) branco. Para isto, foram utilizados 15 dentes de cães, onde após o preparo de cavidades na região cervical da face vestibular e exposição pulpar, estas foram capeadas com MTA branco. Os animais foram sacrificados após 60 dias do término dos procedimentos clínicos e os dentes processados em laboratório para obtenção de cortes histológicos. Foi observada formação de ponte de tecido duro em todas as polpas. em alguns casos, não havia dentina tubular mas somente uma estrutura de aspecto morfológico peculiar, selando a cavidade de exposição pulpar. Apenas dois casos apresentaram inflamação pulpar. Conclui-se que o MTA branco possui as características necessárias de um material para capeamento pulpar.

Response of human dental pulp to dentin adhesive systems

Many in vivo studies have stated that the response of the dentin/pulp complex does not depend on the dental material used as the liner or pulp-capping agent. However, several in vitro studies have reported the metabolic cytotoxic effects of resin components applied to fibroblast and odontoblast cell lines. The aim of this study was to evaluate the human pulp response following direct pulp capping with current bonding agents and calcium hydroxide (CH). Sound premolars scheduled for orthodontic extraction had their pulp tissue mechanically exposed. After hemorrhage control and total acid conditioning, the experimental bonding agents, including All Bond 2, Scotchbond MP-Plus, Clearfil Liner Bond 2, and Prime & Bond 2.1 were applied on the pulp exposure site. CH saline paste was used as the control pulp-capping agent. All cavities were restored with Z-100 resin composite according to the manufacturer's instructions. Following extractions, the teeth were processed for microscopic evaluation. In the short term, the bonding agents elicited a moderate inflammatory pulp response with associated dilated and congested blood vessels adjacent to the pulp exposure site. A mild inflammatory pulp response was observed when Clearfil Liner Bond 2 or CH was applied on the pulp exposures. With time, macrophages and giant cells engulfing globules and components of all experimental bonding agents displaced into the pulp space were seen. This chronic inflammatory response did not allow complete pulp repair, which interfered with the dentin bridge formation. Pulp exposures capped with CH exhibited an initial organization of elongated pulp cells underneath the coagulation necrosis. CH stimulated early pulp repair and dentin bridging that extended into the longest period. The bonding agents evaluated in the present study cannot be recommended for pulp therapy on sound human teeth.

Evaluation of dental pulp repair using low level laser therapy (688 nm and 785 nm) morphologic study in capuchin monkeys

The aim of this study was to evaluate the hypothesis that low-level laser therapy (LLLT) 688 nm and 785 nm accelerate dentin barrier formation and repair process after traumatic pulp exposure. The sample consisted of 45 premolars of capuchin monkeys (Cebus apella) with pulp exposure Class V cavities. All premolars were treated with calcium hydroxide (Ca(OH)(2)), divided in groups of 15 teeth each, and analyzed on 7(th), 25(th), and 60(th) day. Group GI - only Ca(OH)(2), GIF- laser 688 nm, and GIII - laser 785 nm. Laser beam was used in single and punctual dose with the parameters: continuous, 688 nm and 785 nm wavelength, tip's area of 0.00785 cm(2), power 50 mW, application time 20 s, dose 255 J/cm(2), energy 2 J. Teeth were capped with Ca(OH)(2), Ca(OH)(2) cement and restored with amalgam. All groups presented pulp repair. on 25(th) day the thickness of the formed dentin barrier was different between the groups GI and GII (p < 0.05) and between groups GI and GIII (p < 0.01). on 60(th) day there was difference between GI and GIII (p < 0.01). It may be concluded that, LLLT 688 nm and 785 nm accelerated dentin barrier formation and consequently pulp repair process, with best results using infrared laser 785 nm. (c) 2009 by Astro Ltd. Published exclusively by WLLEY-VCH Verlag GmbH & Co. KGaA

Biocompatibility of an adhesive system applied to exposed human dental pulp

Human pulp tissue was directly capped with All Bond 2, or calcium hydroxide and evaluated 7, 30, or 60 days after the procedures. Histological analysis was performed to assess the inflammatory cell response, tissue disorganization, dentin bridging, and the presence of bacteria. At 7 days, with All Bond 2 capping, there was a large area of neutrophilic infiltrate underlying the pulp capping material, and the death of adjacent odontoblasts, was observed. However, with time, the neutrophilic reaction was replaced by fibroblastic proliferation with macrophages and giant cells surrounding globules of resin scattered in the coronal pulp tissue. The persistent inflammatory reaction and hyaline alteration of extracellular matrix inhibited complete pulp repair or dentin bridging. In contrast, at 7 days, the pulp tissue capped with calcium hydroxide exhibited odontoblast-like cells organized underneath coagulation necrosis. Pulp repair evolved into apparent complete dentin bridge formation at 60 days. All Bond 2 did not appear to allow any pulp repair and does not appear to be indicated for direct pulp capping of human teeth. Copyright © 1999 by The American Association of Endodontists.

Healing process of dog dental pulp after pulpotomy and pulp covering with mineral trioxide aggregate or Portland cement.

Considering several reports about the similarity between the chemical compositions of the mineral trioxide aggregate (MTA) and Portland cement (PC), the subject of this investigation was to analyze the behavior of dog dental pulp after pulpotomy and direct pulp protection with these materials. After pulpotomy, the pulp stumps of 26 roots of dog teeth were protected with MTA or PC. Sixty days after treatment, the animal was sacrificed and the specimens removed and prepared for histomorphological analysis. There was a complete tubular hard tissue bridge in almost all specimens. In conclusion, MTA and PC show similar comparative results when used in direct pulp protection after pulpotomy.

Biological response of pulps submitted to different capping materials

Pulp capping is a procedure that comprises adequate protection of the pulp tissue exposed to the oral environment, aiming at the preservation of its vitality and functions. This study evaluated the response of the dental pulps of dog teeth to capping with mineral trioxide aggregate (MTA) or calcium hydroxide P.A. For that purpose, 37 teeth were divided into two groups, according to the capping material employed. Two dogs were anesthetized and, after placement of a rubber dam, their pulps were exposed in a standardized manner and protected with the experimental capping materials. The cavities were then sealed with resin-modified glass ionomer cement and restored with composite resin. After sixty days, the animals were killed and the specimens were processed in order to be analyzed with optic microscopy. It was observed that MTA presented a higher success rate compared to calcium hydroxide, presenting a lower occurrence of infection and pulp necrosis.

Effects of hemostatic agents on the histomorphologic response of human dental pulp capped with calcium hydroxide

Objective: To evaluate the response of human pulps capped with a calcium hydroxide [Ca(OH)2] cement after bleeding control with 2 hemostatic agents. Method and Materials: Pulps were exposed on the occlusal floor, and the bleeding was controlled either with saline solution (SS) or 2.5% sodium hypochlorite (NaOCI) (SH). After that, the pulp was capped with Ca(OH) 2 cement and restored with resin composite. After 30 (groups SS30 and SH30) and 60 (groups SS60 and SH60) days, the teeth were extracted and processed with hematoxylin-eosin and categorized in a histologic score system. The data were subjected to Kruskal-Wallis and Mann-Whitney tests (α = .05). Results: Regarding dentin bridge formation, an inferior response of SH60 group was observed when compared to SS60 (P < .05). The response of the SH30 group generally was similar to that of the groups treated with saline solution. However, after 60 days, 2.5% NaOCl showed a trend toward having an inferior response. Conclusion: Using saline solution as a hemostatic agent before pulp capping with Ca(OH)2 resulted in a significantly better histomorphologic response than using 2.5% NaOCl as a hemostatic agent before capping with Ca(OH)2.

Response of human dental pulp capped with MTA and calcium hydroxide powder

Objectives: To compare the response of human dental pulp capped with a mineral trioxide aggregate (MTA) and Ca(OH) 2 powder. Methods and Material: Pulp exposures were performed on the occlusal floor of 40 permanent premolars. The pulp was then capped with either Ca(OH) 2 powder (CH) or MTA and restored with resin composite. After 30 days (groups CH30 and MTA30) and 60 days (groups CH60 and MTA60), the teeth were extracted and processed for HE and categorized in a histological score system. The data were subjected to Kruskal-Wallis and Conover tests (α=0.05). Results: In regard to dentin bridge formation, CH30 showed a tendency towards superior performance compared to MTA30 (p>0.05), although the products showed comparable results at day 60. In the item Inflammation and General State of the Pulp (p>0.05), CH showed a tendency towards presenting a higher inflammatory response. In the item Other Pulpal Findings, MTA and Ca(OH) 2 showed equal and excellent performance after 30 and 60 days (p>0.05). Conclusion: After 30 days, Ca(OH) 2 powder covered with calcium hydroxide cement showed faster hard tissue bridge formation compared to MTA. After 60 days, Ca(OH) 2 powder or MTA materials showed a similar and excellent histological response with the formation of a hard tissue bridge in almost all cases with low inflammatory infiltrate. © Operative Dentistry, 2008.

Response of human dental pulp to calcium hydroxide paste preceded by a corticosteroid/antibiotic dressing agent

Aim: To evaluate the treatment with corticosteroid/antibiotic dressing in pulpotomy with calcium hydroxide. Methods: Forty-six premolars were pulpotomized and randomly assigned into 3 groups. In Group I pulpal wound was directly capped with calcium hydroxide, and Group II and Group III received corticosteroid/antibiotic dressing for 10 min or 48 h, respectively, before pulp capping. Teeth were processed for histological analysis after 7, 30 or 60 days to determine inflammatory cell response, tissue disorganization, dentin bridge formation and presence of bacteria. Attributed scores were analyzed by Kruskal-Wallis and Mann-Whitney tests (α=0.05). Results: On the 7th day, all groups exhibited dilated and congested blood vessels in the tissue adjacent to pulpal wound. The inflammatory cell response was significantly greater in Group III (p<0.05). On the 30th day, in all groups, a thin dentin matrix layer was deposited adjacent to the pulpal wound and a continuous odontoblast-like cell layer underlying the dentin matrix was observed. On the 60th day, all groups presented a thick hard barrier characterized by an outer zone of dystrophic calcification and an inner zone of tubular dentin matrix underlined by a defined odontoblast-like cell layer. Conclusions: Within the limitations of present study, considering that the treatment was performed in healthy teeth, it may be concluded that the use of a corticosteroid/antibiotic dressing before remaining tissue protection with calcium hydroxide had no influence on pulp tissue healing.